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How Effective Is the Alexander Technique?

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How Effective Is the Alexander Technique? 12 How effective is the Alexander Technique? Julia Woodman BSc, PhD, MSTAT Alexander Technique teacher and Visiting Research Fellow, University of York Alexander Technique is a practical method for self-care which teaches us how to develop greater self-awareness in everyday activities and improve the way we carry out them out. to help people recognise and prevent teachers do not diagnose or treat the unnecessary stress and strain that medical conditions. Nonetheless, I they create in themselves in their usual hope to be able to show some of the ways of sitting, standing, moving ways in which Alexander lessons might In the last issue of Relay, Carolyn and reacting to life in general. People be of benefit to someone with PN . Nicholls described the Alexander discover how to allow their natural Technique and gave some useful First it might be helpful to say a mechanisms of co-ordination and advice that readers could begin to few words about different types of balance to operate more effectively. put into practice. research evidence. In any research With time, they are likely to notice that For anyone who hasn't yet read into healthcare interventions, the gold they are moving with greater ease and Carolyn's article, the Alexander standard is a large, well-designed flexibility and that they feel calmer and Technique is a practical method for self­ randomised controlled trial - or more in control. care which teaches us how to develop preferably, several of them . If a study greater self-awareness in everyday In this article I discuss the research is 'controlled' it means that alongside activities and improve the way we evidence that is currently available the group receiving the intervention carry out them out. The Alexander on the effectiveness of Alexander of interest, there is a second group Technique is usually taught one-to-one Technique lessons in various health­ receiving either a different, already by trained teachers who use gentle related areas. It is important to say established intervention, or standard hand contact and spoken guidance up-front that Alexander Technique care alone, such as that provided by a GP. The results for the two groups can Research in complementary healthcare that can be associated with PN, many then be compared and any changes is particularly challenging because of people also have to contend with back that are not due to the intervention a lack of available research funding pa in and this frequently becomes itself accounted for. For example, compared with con ventional medical a chronic problem. In a large, well­ often some people in a clin ical trial approaches wh ich are often supported designed randomised controlled trial would have got better anyway, so with by funding from the pharmaceutical Alexander Technique lessons were a control group it's possible to find industry. Despite these challenges, shown to lead to significant long­ out how much of the improvement a small amount of high-quality term benefit in people with chronic was actually due to the intervention. research has been conducted on the back pain . The study, known as the If a trial is described as 'randomised' effectiveness of Alexander Technique ATEAM trial, randomly allocated 579 it means that the participants were lessons in some health-related areas. people with chronic, non-specific (the randomly allocated (by computer) to most common type) low back pain the intervention group and the control Randomised controlled clinical to four interventions: 6 Alexander trials of Alexander Technique group. This will minimise any variations lessons, 24 Alexander lessons, 6 lessons in the two groups that could otherwise sessions of massage or a control lead to misleading results . Finally, the To date there have been two group. All patients had continuing trial size is also important as the more randomised controlled trials published access to usual GP care throughout participants in a study, the less the on Alexander Techn ique lessons, one the trial. The resu lts were striking - likelihood of differences in outcome for people with chronic back pain and one year after the trial started, the happening by chance. A randomised, a second for people with Parkinson's group who had received 24 Alexander controlled trial requires a huge amount disease. A third trial is underway (see lessons had only 3 days of pain per of resource to make it happen, both in Looking to the Future). month, compared with 21 days for terms of money and personnel, with the control group who received usual often a large, experienced research On the basis of national estimates it GP care alone (an 86% reduction; see team involved . Smaller, simpler studies is likely that almost half the people figure). Significant improvements also are, nonetheless, useful in exploring reading this article will experience occurred in function and quality of life, new areas and producing preliminary back pain at some time this year. So, with a 42 % reduction in incapacity in evidence that can then be followed up in addition to having to deal with the the 241esson group lessons compared with a larger trial. pa in, numbness, balance problems etc with the control group. How effective is the A .. • t • '"' t • 21 14 20 ..r::. c -0 E '- 15 Q) 0.. c "ffi 0.. 10 . ~ Ul co>-> -o Q) 5 Ol Figure: Number of days with back pain experienced each ~ Q) month: Comparison of effect of Alexander Technique ~ 0 lessons with massage or usual GP care 1 year after the Usual GP Massage 6Aiexander 24 Alexander ATEAM trial began . Care Lessons Lessons Since the reduction in incapacity in participants are increasingly being condition often severely impacts the group who received massage used to explore peoples' attitudes on a person's ability to carry out was no longer significant by one year, and experiences of the intervention . everyday activities. The trial, involving but the reduction in the Alexander At the beginning of the ATEAM trial, 88 individuals, found a significantly groups was maintained, the trial participants were found to have a increased ability to carry out daily tasks authors concluded that the long-term positive attitude to their intervention, following 24 Alexander lessons in benefits of taking Alexander lessons with an expectation for some comparison with usual GP care. These are unlikely to be due to placebo improvement. At the 3-month follow­ benefits remained 6 months after the effects of attention and touch and up, the participants' attitude to the study began . No significant change more likely to be due to active learning Alexander Technique had become was seen in the comparison group and application of the Technique by even more positive as a result of a who received 24 massage sessions, the participants in their daily lives. suggesting that non-specific effects of perceived increased ability to cope with In addition, the trial highlighted the individual care and attention were not and prevent back pain. Participants lack of any significant risks associated responsible for the benefits seen in the with the Alexander lessons, with no reported that the Alexander Technique Alexander group. The study also asked adverse effects reported by any of the 'made sense' and could be practised the participants to comment on what participants in the Alexander groups. while carrying out everyday activities. changes they had noticed and those It is now widely recognised that who had received Alexander lessons It may also be worth mentioning here conventional clinical trials do not commonly reported improvements always capture the whole picture, the randomised controlled trial carried in balance, posture and walking, as and additional techniques such out with indiviauals with Parkinson's well as increased coping ability and as interviewing some of the trial disease. This progressive neurological reduced stress. Examples of improvements in carrying out everyday activities that can result from taking Alexander Technique lessons. In each case, the person on the right is showing improved coordination and posture compared with how she was before. (photos courtesy of STAT, www.STAT.org.uk) Smaller studies Problems with balance can arise from a Interest about the Alexander Technique among number of sources. My own experience researchers is growing and some exciting studies of working with someone with PN was that he found that improvement are currently underway. in his balance and stability was one of the main benefits of the lessons. Unfortunately, there hasn 't yet been who have limited sight. The trial, called Conclusions any research on Alexander lessons and VISIBILITY, is comparing the effect balance in people with PN . However, of usual care provided by a visual While there is a body of Alexander two studies have reported significant impairment charity with that of usual Technique teaching experience improvements in elderly people's care plus 12 Alexander Technique spanning many decades to suggest ability to balance following Alexander lessons. Participants will be assessed that Alexander lessons can be group classes. One was a controlled up to 1 year, using a standard set of beneficial for many different health­ study involving 13 people and the balance and mobility tests. Other related problems, there is currently second was a non-controlled study measures will include fear of falling relatively little clinical research evidence with 19 people; a range of different and emotional well-being. and no trials specifically involving tests were used to assess balance. people with PN. As an Alexander A large, randomised controlled trial Technique teacher I know from my Pain is another area of concern for (ATLAS) looking atAiexanderTechnique own professional experience and that many people with PN and again, lessons for people with chronic neck of my col leagues that people with PN there haven't yet been any studies of pain is also currently ongoing .
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